Phase 1 Year 2: February 2009Copyright @ 2009, University College London Medical School

MGQ paper - extended matching sets

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One hour is allowed for this paper.

There are 80 questions altogether in this paper.

The questions in this paper are arranged in groups of 5; each group is headed by a theme or briefclinical scenario.

There is a list of possible answers, labelled A), B), G), etc for each theme or scenario:Only one answer is correct for each numbered question. lf you mark more than one answer forany single question you score zero for that question. There is no negative marking.

Some answers from the list may be used more than once, some may not be used at all.

You should answer each question numbered 1 - 80 on the lineOf the card that has the same numberas the quesiion, and mark gdy!!93!Sggl from the list.

You are advised to mark your answers on this question paper, then transfer your answers tothe computer-readable card, usinq a Dencil.

Make reasonably firm marks on the card - thin hesitant marks cannot always be read by the computerscanner - but do not press so hard that you indent through the card.

lf you make a mistake, erase your incorrect response as thoroughly as possible, and enter yourrevised answer clearly. Do not "score through" an incorrecl response - the computer will read thisas vour resoonse.

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Theme: evaluation of evidence

Possible answers are:A) ValidityB) Test of heterogeneityC) Relative riskD) ReliabilityE) T{estF) Confidence intervalG) ResponsivenessH) P-valuel) CorrelationcoefficientJ) KappaK) None of the above

From the above list, seleci the one statistical value that is best described by each of the following:

1. The quantity used to summarise inter-rater reliability for a categorical outcome.2. The quantity used to summarise v_gliglity of a measuring instrument with a continuous scale.3. The quantiiy that refers to a measuring instruments sensitivity to change. \-.--4, The quantity used to summarise rg_sllgBsivqgsE of a measuring instrument with a continuous scale.5. The quantity that refers to a measuring instruments ability to correctly measure what it purports.

Theme: ion movements underlying electrical phenomena

A)

D)F)G)H)r)J)

,K)L)

A net inward movement of calcium ionsA net inward movement of chloride ionsA net inward movement of potassium ionsA net inward movement of sodium ionsA net ouhvard movement of calcium ionsA net outward movement of chloride ionsA net outward movement of Dotassium ionsA net outvvard movement of sodium ionsNo net movement of calcium ions since ion is close to eouilibriumNo net movement of chloride ions since ion is close to equilibriumNo net movement of potassium ions since ion is close to equilibriumNo net movement of sodium ions since ion is close to equilibrium

v; From the above list of ion movements, select the one that best describes the flux through the channelsand conditions listed below, all other conditions being those of a typical motoneurone in a healtfrysubject:6. An open voltage qated sodium channel when the membrane voltage is -70 mV.7. An open i6iiElE-@teO sodiuT channel when the membrane voltage is +10 mV.8. An open pe!e.g!j_gm channel when the membrane voltage is -70 mV.9. An open ionotropic glutamate receptor when the membrane voltage is equal to the potassium

equilibrium voltage.10. An open GABA receptor when the membrane voltage is

-20 mV.

Y2 EMQ FEB 09

Theme: dermatome distribution of lower limb

Possible answers are:A) L1B) L2D) L4F) 51\].f Dz

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For each part of the body described below, choose the one nerve root that supplies that area from theabove list of oplions. Each option may be used once, more than once, or not at all.

I 1 . The sole of the foot12. The medial aspect of the anterior lgleg (calf) and big toe.13. The posterior aspect of the upper leg (thigh)14. The posterior aspect of the lower leg (calf)15. The lower-medial aspect of the anterior upper leg (thigh)

Theme: Treatment of Psychosis

A young man was prescribed a drug to control his schizophrenia. However he then suffered frominvoluntary muscle movements, tremor and rigidity. The drug was then changed to another in order toreduce his movement disorders.

Possible answers are:A) AmantadineB) BromocriptineC) ChlorpromazineD) ClozapineE) Dopamine D1 receptorsF) Dopamine D2 receptorsG) Dopamine D3 receptorsH) Muscarinic receotorsl) OestrogenJ) ProgesteroneK) ProlactinL) Selegiline

For each of the following statements or questions select the one most appropriate answer from the listabove:16. The blockade of these receptors is thought to be responsible for the involuntary muscle

movements, tremor and rigidity.17. The first drug that was prescribed caused a high degree of sedation as it also blocks histamine

receptors. Which drug is it?18. Both drugs lead to a high circulating concentration of a hormone, reducing fertility in women.

Which hormone is elevated in response to these drugs?19. The second drug that was prescribed causes agranulocytosis. Which drug is it?20. The movement disorders caused by the first drug can be prevented by prescribing an additional

drug that blocks a different receptor system. However, this causes a dry mouth. Which receptorsystem is blocked by this additional drug?

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Theme: Pain

A middle-aged man has undergone a hernia repair. In the immediate post-operative period he wasgiven two drugs that relieve his pain. He recovered well and returned to work but several months laterhas numbness, burning pain and touch-evoked pain. He is given a different drug.

Possible answers are:A) GlutamateB) ProstaglandinsC) lbuprofenD) DiazepamE) Substance PF) MorphineG) Calcium channelsH) Neuropathic painI) GABAJ) cabaDentinK) Selective serotonin reuptake inhibitors (SSRls)L) 5-hydroxytryptamine (5-HT; Serotonin)

For each of the following statements or questions, select the one most appropriate answer from the listADOVC:21. What transmitter is likely to be involved in spinal transmission of both pain st!!tqs?22. Name one drug that would be used as the first line for the posfoperative p6in.23. Name another drug that also would be used for post-operative pain.24. What drug was he given for the delayed chronic pain25. What is the pharmacological site of action.6f this drug

Theme: Adrenal

Possible answers are:A) Adrenal arteryB) Adrenal capsuleC) Adrenal cortex - Fetal zoneD) Adrenal cortex - Zona fasciculataE) Adrenal cortex - Zona glomerulosaF) Adrenal cortex - Zona granulosaG) Adrenal cortex - Zona reticularisH) Adrenal cortex - Zona reticulatal) Adrenal medullaJ) Adrenal vein

From the above list of regions in the adrenal gland, select the major site of synthesis for each of thefollowing:26. "Adrenal androgens"27. Adrenaline28. Cortisol29. 1 6-Hydroxy-androstenediol30. Mineralocorticoids

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Y2 EMQ FEB 09

Theme: Muscle contraction

Possible answers are:A) ActinB) Blood glucoseC) Calcium ionsD) Hydrolysis of ATPE) Muscle glycogenF) Myasthenia gravisG) MyosinH) Plasma non-esterified fatty acids (nefa)l) Release of ADPJ) Thick filamentK) Thin filamentL) Potassium ions

For each of the following, select the one correct answer from the Iist A - L above:

31. Intracellular (sarcoplasmic) concentration increased in response to cholinergic stimulation atneuromuscular junctions.

32. The protein that is the target for the cyclic peptide phalloidin, which is a product of some toxicmusnrooms.

33. A fall in the RQ (ratio of CO2 produced : 02 consumed) indicates that this is the major fuel beingused by muscle.

34. Increased breakdown in response to activation of phosphorylase kinase by calcium35. The region of striated muscle where myosin is the major protein.

Theme: the hip jointSelect the most suitable term to place in each of the spaces where a word is replaced by a number.Each answer may be used once, more than once or not at all.

A) the femoral nerveB) the obturator nerveC) the hamstringsD) the superior gluteal nerveE) the iliopsoas muscleF) tensor fasciae lataeG) obturator internusH) the inferior gluteal nervel) the sciatic nerveJ) the genitofemoral nerveK) gluteus minimus and medius

The hip joint is siabilized by strong ligaments and muscles. Extension is produced by L361, suppliedby the sciatic nerve, and gluteus maximus, supplied by L37l and is limited to about 15" by theiliofemoral ligament. Medial rotation and abduction are produced by L38l and tensor fasciae latae,

' which are supplied by [_391. 60o of active flexion of the hip is possible, through the action of iliopsoasand rectus femoris. The latter is supplied by L401.

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Y2 EMQ FEB 09

II Theme: the developins eye

Possible answers are:A) They are derived from the outer layer of the invaginated optic cup.B) They are derived from the surface ectoderm of the head.C) Their density is the main determinant of iris colour.D) Most of them degenerate during fetal life.E) They are derived from the anterior epithelium of the lens vesicle.F) They are among the last structures in the eye to begin their differentiation.G) They invade the developing vitreous body.H) Some of them contain a green pigment.l) They are derived from the mesenchyme that surrounds the optic cup.J) They pass through the choroid fissure of the optic cup.

Choose the one description from the list above that best matches each of the following structures:

41 . Primary lens fibres42. Retinal pigment epithelial cells43. Ciliaty muscle cells44. Retinal ganglion cell axons

lL 45. Photoreceotor cells

Theme: the pituitary gland

Select the most suitable term (A - L) to place in each of the spaces where a word is replaced by anumber. Each answer may be used once, more than once or not at all.

A) the anterior cranial fossaB) the body of the sphenoid boneC) the cavernous sinusD) the posterior cerebral arteryE) the sella turcicaF) the superior sagittal sinusG) the anterior cerebral arteryH) the optic chiasml) djrect branches of the internal carotid arteryJ) the inferior sagittal sinusK) the mammillary bodiesL) the posterior cranial fossa

The pituitary gland is located in L461, directly above L471, which is filled by an air sinus. The glandreceives its arterial blood supply from L481. Venous drainage is into L49J, which drains ultimatelyto the sigmoid sinus and internal jugular vein. Anteriosuperior io the gland is [_50J, which may bedamaged by enlargements of the gland.

Y2 EI\,IQ FEB 09

Theme: intracranial sinuses

select the most suitable term to place in each of the spaces where a word is replaced by a number.Each answer may be used once, more than once or not at all.

A) the sigmoid sinusB) the superior petrosal sinusC) the falx cerebriD) the inferior Detrosal sinusE) the cavernous sinusF) the tentorium cerebelliG) a transverse sinusH) the falx cerebellil) the diaphragma sellaeJ) the superior sagittal sinusK) the great cerebral veinL) the pterygoid plexus

The meninges surround the central nervous system. Within the cranial cavity two large folds of durastabilise the brain. One fold, L511, forms a sheet under the occipital lobes, preventing rotation of thebrain around a transverse axis. In its fjxed margin on each side is found L52_1. The other great fold ofmeninges, L53-J, extends between the cerebral hemispheres. In its fixed margin lies 1541, whichends by dralning into a transverse sinus. In the middle cranial fossa the dura covers I 55 I at the sroeof the pituitary fossa (or sella turcica).

Theme: poliomyelitis

Possible answers are:

amoebaDNA virusGram +ve bacteriumGram -ve bacteriumnematode wormRNA virusinfection resulting in the appearance of antibodies but no detectable symptomsinfection of non-human Drimatesmild fever that is over by 6 days after infection with no further symptomsmutation of an attenuated to a virulent strainpost-polio syndrome in adultssignificant death of motor neurones in the spinal cordsignificant death of Purkinje cells in the cerebellumsignificant death of pyramidal cells in the motor cortexsignificant death of sensory neurones in the dorsal root gangliasjgnificant death of skeletal muscle fibres

From the list above, choose the object or phenomenon best described by each ofthe following:56. The result of polio infection in the majority (>90%) of cases.57. That this does not occur is one ofthe reasons why eradication of polio is considered possible.58. The primary lesion that causes limb weakness and paralysis in people who catch polio.59. A phenomenon that can cause risk to parents of children inoculated with Sabin (OPV) vaccine.60. The lnfectious agent in polio.

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Y2 EMQ FEB 09

III Theme: arches and nerves ofthe embryonic pharynx

Possible answers are:A) the first pharyngeal archB) the second pharyngeal archC) the third pharyngeal archD) the fourth pharyngeal archE) the fifth pharyngeal archF) the sixth pharyngeal archG) the trigeminal nerveH) the facial nervel) the glossopharyngeal nerveJ) the vagus nerveK) the hypoglossal nerve

Choose the one item from the list above that best matches each of the following descriptions:

61. lt contains a vessel that will be major conduit of oxygen to the brain.62. lt never has an independent identity in human embryos.63. lt innervates the arch through which the aorta will run.

v, 64. lt passes through several arches but the cells it innervates originated from none of them.-'

65. Some of its fibr-es innervate taste buds but others subserve general sensation.

Theme: Neuromuscular transmission

A patient is given a skeletal muscle "relaxant" drug to aid tracheal intubation in preparation for surgery,and then given another skeletal muscle "relaxant" drug to aid surgery.

Possible answers are:A) cr-adrenoceotorsB) atrooineC) dopamine receptorsD) dyflosE) edrophoniumF) hemicholiniumG) hexamethoniumH) muscarinlcreceptorsl) neostigmine

V J) nicotinic receptorsK) oancuroniumL) suxamethonium

For each of the following statements or questions, select the one most appropriate response from thelist above:

66. The first muscle "relaxant" drug used caused transient muscle twitches (fasciculation). Which drugwas it?

67. Which drug would be used to reverse the effects of the second skeletal muscle "relaxant" drug thatwas used?

68. Both muscle "relaxant" drugs act on the same receptor type and interference with this receptor canalso cause a fall in blood pressure. Which receptor type is involved?

69. Patients with myasthenia gravis are abnormally sensitive to one of the drugs listed above. Whichdrug is it?

70. Which of the drugs listed above is used to diagnose myasthenia gravis?

Y2 EMQ FEB 09

Theme: the action potential.

Possible answers are:A) A large inward current is carried by potassium ions.B) The cell is depolarized from the resting state. The inward current through voltage gated sodium

channels is greater than the outward current through potassium channels.C) The cell is depolarized from the resting state. The inward current through voltage gated sodium

channels is equal to the outward current through potassium channels.D) The cell is depolarized from the resting state. The outward current through potassium channels

is greater than the inward current through voltage gated sodium channels.E) The net current aeross the plasma membrane is zero. Most of the voltage gated sodium

channels are in the ready to open state, that is, they would open if the cell were depolarized.F) The number of voltage gated sodium channels that are open is less than in the resting cell.G) The sodium/potassium ATPase (= the sodium pump) has ceased to function at this time.

Each of the following five graphs represents a plot of membrane voltage against time for an excitable

For each of lines 71 - 75 select the one most appropriate description of the state of an excitable cell atthe time point shown by the thick circle on the graph, from the list above.

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Y2 EMQ FEB 09

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Theme: DepressionA 40 year old woman has been depressed after losing her husband six months ago. She was given adrug and after three weeks her mood had improved significantly. However, because of side effects.she was then given a different drug.

Possible answers are:A) s-HT uotake inhibitionB) 5-HT2 receptor antagonismC) cocaineD) diazeoamE) monoamine releasing agentF) fluoxetineG) imiDramineH) monoamine oxidase inhibitionl) mianserinJ) muscarinicreceptorsK) reserpineL) o2-adrenoceptors

For each of the following statements or questions, select the one most appropriate response for thel ist above:

76. The first drug she was prescribed caused blurred vision and constipation. Which drug was it?77. Both drugs that she was prescribed have the same mechanism of action: what is this mechanism

of action?78. Which of the drugs listed above is not an antidepressant, but has a similar mechanism of action to

the two drugs that this patient was prescribed?79. She hears that there is another group of antidepressant drugs, but certain foods cannot be eaten

when they are being taken. What is the mechanism of action of this group of drugs?80. Which of the drugs listed above can cause depression in patients?

END OF PAPER

Y2 EMQ FEB 09 10